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| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Accounts receivable management - Refunds, payment plans, write-offs - Patient statements, collections |
| Types of Insurance | 21% | - Commercial payers - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Medicare, Medigap, Medicaid |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages |
| Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections |
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NEW QUESTION # 69
The medical prefixes "end-" and "endo-" mean:
Answer: A
NEW QUESTION # 70
Which situation is considered billing fraud?
Answer: A
Explanation:
Billing for services not provided is considered fraudulent activity.
NEW QUESTION # 71
Accounts Receivable Management
Answer: C
NEW QUESTION # 72
Adverse Effect is also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.
Answer: A
NEW QUESTION # 73
EOB
Answer: D
NEW QUESTION # 74
......
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